Community-Acquired Pneumonia in Pregnancy

Abstract

Community-acquired pneumonia is a common disease worldwide, with considerable morbidity and mortality. In the United States, pneumonia complicates 0.5 to 1.5 per 1,000 pregnancies. Physiologic adaptations in the respiratory and immunologic systems may increase susceptibility to pulmonary infections as well as alter their clinical course. Bacterial, viral and fungal pathogens all cause pneumonia in pregnancy, although the causative agent is identified in only 40-60% of cases. The most common single pathogen is Streptococcus pneumoniae, which is identified in 15-20% of community-acquired pneumonia cases in pregnancy. Recent recommendations by the Infectious Diseases Society of America and the American Thoracic Society on the management of community-acquired pneumonia address diagnostic techniques and management schemes for bacterial and viral pneumonias. These guidelines are discussed in the setting of the pregnant woman with community-acquired pneumonia.

Opportunistic Infections in Women With HIV AIDS

“…In the era of ARV use, rates of bacterial pneumonia are decreasing. 7,44 TUBERCULOSIS Mycobacterium tuberculosis (MTB) is associated with 13% of AIDS-related deaths worldwide. Because of immunosuppression and comorbidities such as IVDA, Pseudomonal and Staphyloccal pneumonias are more common among the HIV infected.…”

Prevention and Management of Influenza in Pregnancy

“…8 Pneumonia in pregnancy from either bacterial or viral etiology can predispose to preterm birth. 15 Previous data from 20th century pandemics suggested more specifically a fetal/perinatal impact from maternal influenza infection (increased rates of preterm birth and miscarriage). Recent data have focused increasing attention to heightened rates of preterm birth but have also suggested a potential link between maternal influenza infection and fetal growth disturbances.…”

“…Viral and bacterial pneumonias can be particularly aggressive, especially during pregnancy and the early postpartum period. 15 Nonrespiratory complications occasionally noted among patients with influenza include pericarditis, myositis, encephalitis, and Guillain-Barre syndrome.…”

“…Given the challenge of clinically differentiating primary viral influenza pneumonia, bacterial pneumonia, or a combination, many practitioners prescribe antibiotics empirically along with antiviral drugs to cover for both pathogens until more specific diagnostic information becomes available. 15 The standard approach to the management of critically ill pregnant patients is similar to that of the general population. Stabilization of airway, breathing, and circulatory status is no different in pregnancy.…”

Oseltamivir for influenza in pregnancy

“…Multiple investigations have demonstrated higher rates of pre-term birth and compromised fetal growth among women suffering from influenza in pregnancy. 8–11 Given these noted complications from influenza in pregnancy, prevention of infection is of paramount importance.…”